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Figure 1: Various patterns of % GSA and % CT on 3D-99mTc-GSA scintigraphy/vascular fusion images in case 11. (a) CT image (planned resection
region); (b) partial hepatectomy; (c) partial hepatectomy; (d) segmentectomy (S6); (e) segmentectomy (S6); (f) right lateral sectionectomy; (g) right lateral
sectionectomy; (h) right hepatectomy on 3D-99mTc-GSA scintigraphic image; (i) right hepatectomy on 3D-vascular image. % CT: conventional volume ratio
of planned resection region without tumor; % GSA: functional volume ratio of planned resection region without tumor

Table 1: Discrepancy ratio between % CT and % GSA
Case Age Gender Disease Liver Operation HH15 LHL15 % CT % GSA Discrepancy ratio%
1 60 M HCC CH Right hepatectomy 0.71 0.84 33.2 33.7 -2
2 76 M Meta Normal Right hepatectomy 0.74 0.94 66.3 66.4 0
3 72 M HCC Normal Left hepatectomy 0.44 0.94 42.7 19.0 56
4 65 F ICC Normal Left hepatectomy 0.56 0.92 21.6 12.5 42
5 78 F Meta Normal Left hepatectomy 0.62 0.90 32.9 29.1 12
6 68 M Meta Normal Right posterior sectionectomy 0.57 0.96 28.9 25.5 12
7 74 M Meta Normal Right posterior sectionectomy 0.70 0.86 27.5 23.5 15
8 77 M Meta Normal Right posterior sectionectomy 0.70 0.92 25.5 23.2 9
9 71 F HCC LC Segmentectomy (S6) 0.74 0.88 12.2 11.7 4
10 77 M Meta Normal Segmentectomy (S8) 0.61 0.92 17.0 12.0 29
11 81 F HCC LC Partial hepatectom (S8) 0.88 0.72 6.6 5.1 23
12 77 F Meta Normal Partial hepatectomy (S6) 0.56 0.96 1.3 1.1 15
13 78 M Meta Normal Partial hepatectomy (S6) 0.54 0.94 1.6 0.4 75
14 69 M Meta Normal Partial hepatectomy (S8) 0.60 0.92 2.6 2.7 -4
15 68 M Meta Normal Partial hepatectomy (S8) 0.68 0.88 2.9 2.2 24
AV 72.7 0.64 0.90 21.5 17.9 20.7
SD 5.6 0.10 0.06 17.6 16.7 21.4
HCC: hepatocellular carcinoma; Meta: metastatic liver tumor; ICC: intrahepatic cholangiocarcinoma; LC: liver cirrhosis; CH: chronic hepatitis; % CT:
conventional volume ratio of planned resection region without tumor; % GSA: functional volume ratio of planned resection region without tumor; Discrepancy
ratio: (1-% GSA % CT) × 100; AV: average value; SD: standard deviation

The SYNAPSE VINCENT system has already been tested volume could be compared with the functional volume of
in various surgical fields, [29-32] and techniques for its use the planned resection region of the liver. The % GSA and
have been refined. The system has been greatly helpful % CT could also be calculated and compared.
in previsualizing intraoperative scenarios. In fact, the
time required for intraoperative confirmatory US was In conclusion, 3D- 99m Tc-GSA scintigraphy/vascular fusion
considerably shortened after the introduction of this imaging performed with the use of SYNAPSE VINCENT
technology. This system is relatively easy to operate, is useful for non-invasive functional liver volumetry
allowing even a novice user to create 3D images. in patients scheduled to undergo various patterns of
planned hepatectomy. There was a discrepancy between
3D- 99m Tc-GSA scintigraphy/vascular fusion images could the results of conventional and functional volumetry.
also be easily created with the use of SYNAPSE VINCENT. In the planned resection region without tumor, the
It was possible to select the portal venous branch to be functional volume ratio estimated with SYNAPSE
resected on the 3D-vascular images, and the conventional VINCENT was about 20% lower than the conventional
190 Hepatoma Research | Volume 2 | July 1, 2016